1. Advocacy and Leadership Skills in Sustainable Healthcare Kate Charlesworth NHS Sustainable Development Unit Sustainable Healthcare Education Learning objective 4 http://greenerhealthcare.org/sustainable-healthcare-education

2. Introduction Q1. Why is advocacy an important skill for doctors? Q2. What do you need to learn, and what skills do you need to practice, in order to make you better advocates for action on sustainable healthcare?

3. Change management What is the scale of the challenge for carbon reduction in the NHS? Why should I do anything about it? What are the barriers? What are our opportunities? What can I do? What models can I use?

4. Whose job is it to change “the system”? Managers? Doctors? Healthcare charities? In the future, do you see yourself as somebody who would initiate a service change such as a new type of clinic? Why / why not?

5. Personal qualities, ethics, values

6. Current generations Future generations People nearest People with resources People most in need ‘Us’ ‘Them’ cure prevention Ethical questions we need to think about

7. What behaviour change and organisational (/environmental) change models do you know of, if any?

8. *Social learning theory (modelling: people watch others’ behaviour, then adopt similar behaviours); *Health belief model (people consider: their susceptibility to the illness/danger, the perceived seriousness of it, the costs and benefits of change, and then make a decision whether or not to change); *Stages of change model (individuals move from a stage of contemplation through to preparation for change and finally maintenance or relapse from a change).

9. 8 stages of Change Management (John P. Kotter) 1.Increase Urgency 2.Build the Guiding Team 3.Get the Vision Right 4.Communicate for Buy-In 5.Empower Action 6.Create Short Term Wins 7.Don’t Let Up 8.Make Changes Stick

10. I HEAR …and I forget I SEE …and I remember I DO …and I understand Helping people deliver change

11. Why don’t some behaviour change interventions work? (and so people don’t change?)

12. they don’t reach or appeal to the target audience; the message isn’t relevant/ personalised; the change is inconsistent with a person’s beliefs and values, or with their social relationships and norms, the ‘role model’ is not perceived as being credible; the change is not achievable within a person’s life circumstances: that is, there are physical/social/cost barriers (e.g. no safe footpaths or green spaces close- by in an attempt to increase walking); the change is not reinforced; the individual is excluded from taking a proactive role in the process (they don’t have ‘ownership’), etc.

13. What do you think the common barriers are to health professionals not acting on climate change/sustainability?

14. Q4. What can we learn from our efforts to change people’s behaviour in relation to other health issues? (eg tobacco)

15. In what ways can doctors influence the sustainable healthcare agenda? How influential do you think doctors are in local communities? How do you feel about these responses? ‘I spend my whole day saving lives, now you want me to save the planet as well?’ What has climate change got to do with medicine?’ From a General Practitioner: ‘My patients have enough to worry about’

16. Becoming effective advocates: strategies for creating a support network to increase the effectiveness of professional actions

17. NHS Sustainable Development Unit www.sdu.nhs.uk